2015 Benefits Enrollment
SUPPLEMENT
Human Resources n Finance & Administration
FOR PRE-MEDICARE RETIREES
November 2014
This newsletter supplement concerns current pre-Medicare-eligible retirees and spouses.
References to “retirees” generally includes surviving spouses.
2014 Key Dates
November 3
Open Enrollment Begins
Weeks of November 10
and November 17
Retiree Meetings
December 3
Open Enrollment Ends
Rochester Institute of Technology
Department of Human Resources
George Eastman Hall
8 Lomb Memorial Drive
Rochester, New York 14623-5604
250-P1659Supp-11/14-HUB-AGL
© 2014 Rochester Institute of Technology
2015 OPEN ENROLLMENT BEGINS
This year, we are adding this Pre-Medicare Retiree Supplement
to the retiree newsletter, for only those retirees and their covered
spouses/partners who are not yet covered by Medicare. The
changes that are described in this Supplement apply only to
pre-Medicare retirees. The reasons we have chosen to take this
approach are:
• To avoid confusion for the Medicare retirees, spouses/partners,
• To save on printing and mailing costs, and
• To be more environmentally conscious by not producing
unnecessary pages.
Information contained in the main Retiree edition newsletter
are topics of general interest to both Medicare and pre-Medicare
retirees as well as information that concerns the Medicare plans.
We hope this approach will make it easier for you.
You will find other helpful information on the HR website
at www.rit.edu/benefits, including the Medical Benefits
Comparison Book for Employees and Pre-Medicare Retirees.
Prescription Drug Updates
EXPRESS SCRIPTS UPDATES LIST OF EXCLUDED DRUGS
Express Scripts has announced an
expansion of its list of excluded
medications for 2015, bringing
the total to 66. You can find the
updated list, 2015 Preferred
Drug List Exclusions, on the Open
Enrollment page and the Medical
and Prescription Drug page of the
HR website at www.rit.edu/benefits
and on www.express-scripts.com.
If you are currently filling
prescriptions for any of the
medications that will be newly
excluded beginning January 1, 2015,
Express Scripts will send a letter
to you and your physician this fall.
Alternative covered medications are
provided, and you should contact
your physician about the alternative
medications before you need to fill
a prescription on or after January 1.
Please note that if you continue to
fill the excluded medication after
December 31, 2014, you will be
required to pay the full cost (with no
discount) at the pharmacy, and the
Plan will not reimburse you for any
part of the cost. The amount you pay
will not count toward the out-ofpocket maximum under the plan.
Express Scripts has a clinical
exception process; if your physician
believes you need to remain on your
current medication for a clinical
reason, your physician can request
a medical exception review by
contacting Express Scripts. We have
been informed by Express Scripts that
a very small number of its members
pursued an exception for 2014. For
the vast majority, one of the suggested
alternative medications was
acceptable.
There are three drugs that are
excluded in 2014 that will be made
available to patients in 2015: Advair
(which will be a non-preferred drug,
Tier 3), Auvi-Q, and Stelara (which
will be preferred drugs, Tier 2).
If you were previously on one of
these medications and switched to
an alternative, you have the choice to
continue the current medication or
switch back to the previous one.
You may recall that Express Scripts
initiated this strategy beginning in
2014 in response to actions by several
large brand drug manufacturers to
recoup market share lost to generic
equivalents. Other national
pharmacy benefits managers
have taken similar steps to help
control cost escalation. Express
Scripts reports that this strategy
has been successful in encouraging
pharmaceutical manufacturers to
provide competitive rates.
If you have questions, please contact
Express Scripts member services.
BREAST CANCER DRUGS
Another change effective January
1, 2015, under the Affordable Care
Act (ACA) is an update to the 2002
U.S. Preventive Services Task Force
recommendation on the use of
medications for breast cancer risk
reduction. There will be a $0 copay
for risk-reducing generic medications
(tamoxifen or raloxifene) for women
age 35 and older who have not had
a breast cancer diagnosis, who are
at increased risk for breast cancer,
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November 2014 n Human Resources n Finance & Administration
and who are at low risk for adverse
medication effects. Those covered
under POS D do not need to meet
the deductible before the $0 copay
will apply.
It is important to note that the Task
Force did not approve a $0 copay for
women who have been diagnosed
with breast cancer in the past or for
women who are not at increased risk
for breast cancer.
REMINDER ABOUT PURCHASING YOUR MEDICATIONS AT WEGMANS
RIT is continuing its successful
preferred pharmacy arrangement
with Wegmans Pharmacies for 2015.
About 70% of all retail medications
dispensed under RIT’s prescription
drug plan are purchased at Wegmans.
As a reminder for those who have not
made the switch, refer to the chart
below to see the savings at Wegmans
compared to other retail pharmacies.
If you take a maintenance medication
(a medication you take for an ongoing
condition such as to reduce blood
pressure), and it is not convenient
for you to go to a store, you may be
interested in Wegmans’ free home
shipping service. Contact Wegmans
for more details at wegmans.com or by
calling 1-800-934-4797.
POS A and POS B
Wegmans pharmacy
Category
Other participating retail
Express Scripts
mail
30-day supply,
no limit on fills
90-day
supply
30-day supply,
up to 3 fills
30-day supply
4th fill and after(1)
90-day supply
Tier 1: Generic Drugs
$10.00
$25.00
$12.00
$30.00
$25.00
Tier 2: Brand Name Formulary Drugs
$25.00
$62.50
$30.00
$75.00
$62.50
Tier 3: Brand Name Non-Formulary Drugs
$40.00
$100.00
$50.00
$125.00
$100.00
POS D
Wegmans pharmacy
Category
30-day supply,
no limit on fills
90-day
supply
Other participating retail
30-day supply,
up to 3 fills
30-day supply
4th fill and after(1)
Express Scripts
mail
90-day supply
Annual Deductible—each person must pay $1,000 annual deductible before copay amounts are charged in a plan year
Tier 1: Generic Drugs
$20.00
$50.00
$25.00
$62.50
$50.00
Tier 2: Brand Name Formulary Drugs
$60.00
$150.00
$70.00
$175.00
$150.00
Tier 3: Brand Name Non-Formulary Drugs
$120.00
$300.00
$140.00
$350.00
$300.00
(1) applies to maintenance medications only; does not apply to acute medications or medications that cannot be filled through mail order (e.g., certain
controlled substances)
November 2014 n Human Resources n Finance & Administration
3
RGHS HAS MERGED WITH UNITY HEALTH SYSTEM
As you may have read
recently, with the merger of
Rochester General Health
System (RGHS) and Unity
Health System, the new
combined system has a new
name: Rochester Regional
Health System (RRHS).
Both organizations continue
to work on merging their
provider networks with an
expected completion date
of January 1, 2015.
While the name has
changed, RIT’s alliance with
the former RGHS has not.
RIT’s POS medical plans
continue to include the
newly named RRHS Copay
Option. The lower copays
are made possible because
a study of costs across the
Rochester area shows that,
on average, costs at RRHS
are often lower than at other
systems. Under this option,
there is a lower copay when
you obtain the following
medical services from RRHS
providers:
• office visit to primary
care physician (PCP)
• office visit to specialists
• emergency room visits
4
• inpatient hospitalization
• outpatient facility
The lower copays do not
apply to tests, treatments,
or any other services (e.g.,
allergy shots, chiropractic
services, X-rays, etc.).
You will find the details
by service in the Medical
Benefits Comparison Book
found on the HR website
on the Open Enrollment
page and the Medical and
Prescription Drug Coverage
page.
If you are looking for
an RRHS provider, please
remember that RRHS offers
the RRHS Find-a-Physician
Service to help you find
RRHS providers. You will
find details on the HR
website. In addition, RRHS
has provided RIT with
a listing of participating
providers that we have
posted on the HR website.
Since the list is 129 pages,
you can search for any of
the fields in the file (name,
specialty, etc.) instead of
printing it. Simply hold
down the Ctrl key (the 
November 2014 n Human Resources n Finance & Administration
Command key for Macs)
and press the F key, then
enter the text you are
searching for and click Next.
We have received feedback
from participants that
some providers have not
charged the lower copay
at the time of service. We
are continuing to work
with Excellus BlueCross
BlueShield and RRHS to
improve the process to
ensure patients are charged
the appropriate lower copays
by RRHS providers and
facilities. One change we are
making is an update to the
ID cards to show both the
RRHS and non-RRHS copay
amounts. All participants
will receive new ID cards in
late December. While your
ID number will remain the
same, the 3-digit prefix in
front of the ID number will
change. This new prefix
indicates to the provider’s
office that the RIT plan is
not a standard POS plan.
In addition, Excellus will
be sending a mailing to
RRHS providers to remind
them of the special copay
arrangement for RIT plan
participants.
It is important for you to
know that when Excellus
processes a claim, they
process it based on the
correct copay, regardless
of the copay the provider
charged you. Therefore,
if you believe you are
charged an incorrect
copay, you can refer to the
monthly Health Summary
Excellus sends you or log
in to your account on its
website to see how the
claim was processed. If you
determine that you were
overcharged, you should
contact the provider directly
(Excellus reimburses
the provider based on
the correct copay). We
know that some providers
automatically issue a refund
check and others hold the
overpayment as a credit on
your account; in this case,
you can contact the provider
and request that the amount
be refunded to you.
As the RRHS transition
continues to evolve, we will
keep you informed.